Frequently Asked Questions about Therapy.

I often tell people, “It’s like writing a letter: Dear Dree,” and I’ve had several, visually-oriented people tell me, “Oh, I just picture a deer and a tree.”

Our names are important to us and I will confess that I enjoy hearing mine said correctly but I promise I will answer to anything close.

I know it can feel awkward when we’re unsure how to say someone’s name. Please know I’ll be gracious. I seriously doubt you will miss the mark as badly as some did when I was younger.

I attended a birthday party when I was 11 years old where my name tag and favors were all labeled “Beatrice.” I also had a pre-assigned work table in a college chemistry lab labeled “Desiree Station.”

What is a therapy session with you like?

Over the years, I’ve found that often below this question is the spoken or unspoken worry, “Are you going to just look at me and expect me to talk?” So, let me start by assuring you, no, that is not my style.

I am very engaged and interactive in sessions, trying to facilitate what are sometimes difficult conversations in as safe and comfortable a manner as possible. If you tend to be quiet, I can help draw you out with questions. If you are more loquacious, I will follow you with occasional guiding nudges or clarifying questions.

I see my role as an ally or partner and I will try and balance my energy and efforts to match yours.

If you come in ready to dive deep into an issue or are eager to learn a new skill, I will be ready.

If you come in and feel drained, perhaps having had urges to not even come, we can focus more on the present moment and helping shift your energy and mood.

If you arrive feeling emotionally overwhelmed or dysregulated, I will probably offer to guide you in some skill or meditation to help you settle before moving into the session.

If you come to session and just want to chat and stay on the surface, we can do that. However, if you do that often, I will gently remind you of your previously stated goal(s) and help you explore what’s making it difficult to take steps in the direction you want to head. I wouldn’t be much of a partner on the journey if I let us camp out indefinitely at a scenic overlook without reminding you of where we were headed to begin with.

I have found that I can be more mindful and fully present with my clients if I’m not watching the clock, so I use a meditation timer in sessions. When the ending chimes ring, it’s not intended to communicate, “BING! TIME’S UP!” Please don’t run from the room! The ending chimes are just a gentle reminder for us to move toward wrapping up.

Taking care of payment and scheduling other sessions is often easiest at the beginning of the session, particularly if you anticipate tapping into some difficult emotions. It can sometimes feel challenging to take care of these details at the end. I will respect your preference, though, on when you want to conduct this business.

We can arrange a free phone consultation during which I can get a better idea of what you are seeking and you can ask me any questions you might have.

Having a phone conversation helps us assess whether we might be a good fit working together, which is critical for successful therapy.

I look forward to talking with you!

What region(s) do you serve?

My office is located in Harrisonburg, VA, which makes it easily accessible to residents of Rockingham County. I also frequently see clients from Albemarle, Augusta, Shenandoah and Page Counties.

As a Licensed Clinical Social Worker, I am licensed to see clients anywhere in the Commonwealth of Virginia. I do see clients via live online video conferencing.

I don’t live in/near Harrisonburg. Can I still work with you?

Yes! As long as you live within the Commonwealth of Virginia, my professional license permits me to work with you.

Live online video sessions can be held via a secure, HIPAA compliant system. All you will need is Adobe flash player, a web cam and high speed internet connection. Whenever possible, it can be helpful for both of us to have an initial in-person session but this is not absolutely necessary.

Do you accept my insurance?

I do not accept insurance but am willing to create a Superbill, an itemized receipt listing the services provided, which you can submit to your insurance for possible reimbursement. In all honesty, some clients receive partial reimbursement but many are not reimbursed at all.

If using your insurance for therapy is financially necessary, I recommend that you contact your insurance provider and ask whether you can be reimbursed for seeing an out-of-network provider and at what rate. If your insurance provider does not reimburse (at all or enough), please ask them for names of providers in their network.

Insurance companies require therapists to diagnose their clients. It is a condition of the therapist getting paid. These labels or diagnoses become a part of the client’s permanent medical record even when the individual improves and no longer meets criteria for that diagnosis. There are also times that I see clients who do not meet criteria for any diagnosis. I believe it is unethical to label someone in order to appease the insurance company.

Insurance companies can dictate the treatment that occurs (i.e., focus, treatment plan, number of sessions, etc.) rather than this being an independent collaboration between client and therapist.

Your records are not private. Just as insurance companies review your medical records, insurance claims specialists can request and review your therapy records. It is my understanding that information seen by your insurance company can impact clearance for certain types of jobs and some clients feel more protective of the information shared in therapy compared to information shared with their physician.

Therapy routinely involves the sharing of sensitive information and I take the steps necessary to protect your confidentiality. I use a state of the art service for scheduling, documentation, messaging clients and online video sessions. The site is HIPAA compliant, all traffic is secure, all sensitive data is encrypted, no sensitive data is sent via email and only notifications to login to the system will be sent.

Legally, information from sessions and records cannot be disclosed without your written permission and my Release of Information form allows you to specify what you do and do not want shared. However, the Code of Virginia does state that a client’s information can be shared without her consent under the following circumstances:

If a client shares an intention to harm herself. In such cases, I will make every effort to enlist her collaboration in developing a safety plan. If the client is unable or unwilling to cooperate, I will take further steps, as provided by the law, to ensure her safety.

If a client threatens to kill or seriously harm another person(s), I must notify the police and intended victim(s).

As a Licensed Clinical Social Worker, I am mandated to report to the Virginia Department of Social Services any known or suspected abuse, neglect or exploitation of children, the elderly or disabled adults.

If a court of law subpoenas clinical records and/or testimony.

Finally, I think it’s worth touching on what to expect if/when we see each other in public outside of sessions. Please don’t think I’m rude, but I will not approach you or speak if I see you out somewhere. This is to protect your privacy. OK, I confess, I will probably spontaneously smile when I see you, but I smile at strangers too, so I won’t be outing you in any way. The reason I won’t come up to you is to keep our relationship confidential. You might be with other people and not want to answer the question, “Who is she?” Or I might be with other people and you don’t want them asking how I know you. It is fine with me if you want to approach and say hi but please understand that I do not expect it. You get to decide each and every time depending on the circumstances, and if you approach me, we will not talk about therapy-related matters.

What do I do if I’m in crisis?

If you are having a mental health crisis and/or thoughts of self-harm/suicide, please do one of the following:

Current clients may call me, but if I am unable to answer, please take one of the preceding courses of action.

Do you work with children?

While I enjoy children, I do not have training or experience in providing therapy to them. Therefore, I work with college-aged adolescents and older.

Do you provide therapy to couples and/or families?

There are talented therapists who specialize in working with couples and families and I do not count myself among them. My strengths are in individual and group therapy.

How does therapy differ from talking to a friend?

Talking to a trusted friend who really gets you feels great, yet despite supportive friends, people sometime realize that their struggles are not improving. Talking to a therapist differs from talking to your best friend(s) in these ways:

Therapists are trained professionals. We have advanced degrees and training in human behavior, relationships and effective interventions. As a social worker, I use a biopsychosocial-spiritual perspective, assessing the many variables that influence my client’s life and wellbeing. I also use evidence-based treatments to guide my therapy practice.

Therapists are objective. Sometimes, we need someone who can provide a neutral, non-judgmental perspective. Friends and family have a vested interest in your life and choices whereas a therapist does not. Of course, therapists lose objectivity with their own friends and family and cannot ethically counsel them.

Therapists don’t offer advice. This surprises some people and I’ve even had clients say, “Just tell me what to do.” My role as a therapist is to help you clarify your own goals and values, learn to listen to your inner wisdom and perhaps teach you the skills you need to move toward your desired goals. I’m not here to tell you how to live your life, just help you be as successful as possible in living life your way.

Therapy is confidential. There are actual state and federal laws dictating that I protect your privacy. This is part of what makes it safe to explore and work through those more vulnerable parts of your life. Confidentiality helps create a secure environment to learn how to and practice talking about emotions and tough topics.

Therapy focuses on you and comes with clear boundaries. My only agenda is to help you identify and align with your best and highest self. Even if I choose to share personal information or a story, it is with the goal of trying to help move you forward on your path.

What is EMDR?

Eye Movement Desensitization and Reprocessing or EMDR is an evidence-based therapy for treating Post Traumatic Stress Disorder (PTSD) and trauma-related symptoms. It utilizes back-and-forth eye movement, alternate hand tapping or audio stimulation to activate both hemispheres of the brain so that traumatic memories can be rapidly processed in a manner unlike traditional talk therapy. The strange sound of such an approach contributed to it becoming one of the most well-researched trauma treatments.

I have over 15 years of experience with this therapy and have seen it remarkably transform the quality of life experienced by individuals who have experienced trauma.

I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, Google+, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

I keep a Facebook Page for my professional practice to allow people to share my posts, practice updates and news about workshops with other Facebook users. You are welcome to view my business Facebook page and read or share articles posted there, but I do not accept Reviews from former or current clients. While this has been disappointing to appreciative clients who want to support me, it jeopardizes their confidentiality. Furthermore, the National Association of Social Workers’ Code of Ethic prohibits my soliciting testimonials from clients.

Where are you from?

Although born in North Carolina, I grew up as a Third Culture Kid (TCK), which means I spent my formative years growing up outside of the United States in Ethiopia, Kenya and Tanzania. As a TCK, I moved often, experienced a variety of cultures, witnessed war, famine and many challenges of third world cultures, saw some of the most breathtaking sights in the world, and had some thrilling adventures.

A common experience for TCK’s is being able to fit in anywhere but lacking a sense of belonging. I wasn’t African and I didn’t feel like an American. It’s kind of embarrassing to admit this, but my brother and I thought we invented a term to accurately describe our in-between-not-fully-one-thing-or-another status. We referred to ourselves as “African-American.” Only when we moved back to the States did we realize that we didn’t have the only claim on this label.

I have lived in Virginia most of my adult life and have established a sense of roots and feeling at home. As a therapist, I of course now understand that the experience of fitting in but not belonging can also be true for people who have lived their whole lives in the same place. I had to do my own personal work around creating a sense of belonging and I enjoy helping others do the same in their lives.